Question

Two hours later Mrs. Mason is using shallow-chest breathing to cope with contractions. Assessment findings: BP 120/80 mmHg. P. 90 R 26; contractions are every two minutes, lasting 65 seconds, strong to palpation; moderate bloody show with clear amniotic fluid; pain rated at 6/10, c/o increasing back pain. Sterile vaginal exam: 8 cm, 100%, 0 station. SELECT THE FIRST TWO NURSING ACTIONS IN THE ORDER THAT THEY SHOULD BE IMPLEMENTED:

a. Praise her efforts and tell her that she is almost ready to deliverDecrease anxiety and encourage on-going use of techniques. Decreasing anxiety can facilitate labor and should be the initial nursing action.
b. Encourage her to void at least every two hoursAvoid bladder distention which can impede fetal descent; promote comfort.
c. Assist her with peri-care and change underpads as neededProvides comfort and prevents infection
d. Teach husband how to apply counter-pressure to woman's back during contractions while sitting on birthing ball.Relieves back pain that may be associated with fetal posterior position; encourages pelvic mobility and perineal relaxation to encourage fetal descent
e. Continue to provide comfort measures and minimize distractions in roomDecrease discomfort and aid in focus on non-pharmacologic labor techniques

Answer 1

Janine is given Pitocin to induce labor since she is past 41 weeks with minimal progress in dilation and contractions. Pitocin accelerates the positive feedback loop essential for labor progression. A newborn's first breath dramatically changes their circulatory pattern, transitioning them to independent pulmonary circulation.

Step-by-step explanation:

Induction of Labor with Pitocin

Janine is 41 weeks pregnant and experiencing prolonged, unprogressive labor. The use of an IV infusion of Pitocin, synthetic oxytocin, is initiated to stimulate contractions and to facilitate the progress of labor through the positive feedback loop of childbirth. This loop involves the cervix dilating and the uterine contractions becoming more frequent and stronger, which helps the cervix to efface and the labor to continue moving toward delivery.

Circulatory Changes post-Newborn's First Breath

The newborn's first breath causes significant circulatory pattern changes. The lungs expand, reducing pulmonary resistance, and increasing blood flow through the lungs. This facilitates the closure of fetal circulatory shunts and the transition to independent pulmonary circulation.